Alcohol-focused and transdiagnostic treatments for unhealthy alcohol use among adults with HIV in Zambia: A 3-arm randomized controlled trial

Michael J Vinikoor, Anjali Sharma, Laura K Murray, Caleb J Figge, Samuel Bosomprah, Chipo Chitambi, Ravi Paul, Tukiya Kanguya, Suilanji Sivile, Van Nghiem, Karen Cropsey, Jeremy C Kane, Michael J Vinikoor, Anjali Sharma, Laura K Murray, Caleb J Figge, Samuel Bosomprah, Chipo Chitambi, Ravi Paul, Tukiya Kanguya, Suilanji Sivile, Van Nghiem, Karen Cropsey, Jeremy C Kane

Abstract

Background: Clinical and quality of life outcomes in people living with human immunodeficiency virus (PLWH) are undermined by unhealthy alcohol use (UAU), which is highly prevalent in this population and is often complicated by mental health (MH) or other substance use (SU) comorbidity. In sub-Saharan Africa, evidence-based and implementable treatment options for people with HIV and UAU are needed.

Methods: We are conducting a hybrid clinical effectiveness-implementation trial at three public-sector HIV clinics in Lusaka, Zambia. Adults with HIV, who report UAU, and have suboptimal HIV clinical outcomes, will be randomized to one of three arms: an alcohol-focused brief intervention (BI), the BI with additional referral to a transdiagnostic cognitive behavioral therapy (Common Elements Treatment Approach [CETA]), or standard of care. The BI and CETA will be provided by HIV peer counselors, a common cadre of lay health worker in Zambia. Clinical outcomes will include HIV viral suppression, alcohol use, assessed by audio computer-assisted self-interview (ACASI) and direct alcohol biomarkers, Phophatidylethanol and Ethyl glucuronide, and comorbid MH and other SU. A range of implementation outcomes including cost effectiveness will also be analyzed.

Conclusion: Hybrid and 3-arm trial design features facilitate the integrated evaluation of both brief, highly implementable, and more intensive, less implementable, treatment options for UAU among PLWH in sub-Saharan Africa. Use of ACASI and alcohol biomarkers will strengthen understanding of treatment effects.

Keywords: HIV; Phosphatidylethanol; Sub-Saharan Africa; Transdiagnostic therapy; Unhealthy alcohol use.

Conflict of interest statement

Declaration of Competing Interest All authors declare they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2023. Published by Elsevier Inc.

Figures

Fig. 1.
Fig. 1.
Schema for a 3-arm hybrid clinical effectiveness-implementation trial for unhealthy alcohol use among adults with HIV in Zambia.

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